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Education Enrollment Form

We're so glad that you've decided to sign up for a class at the Players Guild Theatre. Please fill out the form below, in its entirety, and be sure to have a credit card on hand to make your payment, as the form will not submit without a valid credit card.

NO REFUNDS will be issued unless requested and approved 10 days prior to the start date of classes, workshops and lessons.

Class Information

Today's Date	Required* //
Session	Required*
Class Selection	Required*

Student Information

Student Name

First Name*

Last Name*

Student Birthdate

Required* //

Age of Student

Required*

Parent or Guardian (if applicable)

First Name

Last Name

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* -- ext

Required*

Would you like to be added to the Players Guild e-mail list?
Required*

	Yes
	No

Payment Information

Please check the box that corresponds to the class(es) you wish to take.

Shopping BasketRequired*

		Selection	Extended

	Teen Class \| $100.00
	Adult Class \| $50.00
	Teen Full Year \| $250.00

Order Summary

Subtotal
Discount
Sales Tax
Shipping & Handling
Total

Payment Type Credit Card

Credit Card

Name on Card
First Name*	Last Name*

Card Number* - - -

Accepted Types

Security Code (CVV2)* | What's this?

Expiration Date*

Billing Address

Street 1*

Street 2

City*

State*

Zip*

Provide the billing address

Phone Required* -- Provide a contact phone number for the billing contact.

Education Enrollment Form

Teen Class | $100.00

Adult Class | $50.00

Teen Full Year | $250.00